title: Geriatric assessment improves prediction of surgical outcomes in older adults undergoing pancreaticoduodenectomy: a prospective cohort study.
abstract: OBJECTIVE
  To prospectively evaluate the additional value of geriatric assessment (GA) for predicting surgical outcomes in a cohort of older patients undergoing a pancreaticoduodenectomy (PD) for pancreatic tumors.
  
  
  BACKGROUND
  Older patients are less often referred for possible PD. Standard preoperative assessments may underestimate the likelihood of significant adverse outcomes. The prospective utility of validated GA has not been studied in this group.
  
  
  METHODS
  PD-eligible patients were enrolled in a prospective outcome study. Standard preoperative assessments were recorded. Elements of validated GA were also measured, including components of Fried's model of frailty, the Vulnerable Elders Survey (VES-13), and the Short Physical Performance Battery (SPPB). All postoperative adverse events were recorded, systematically reviewed, and graded using the Clavien-Dindo system by a surgeon blinded to the GA results. Multivariate regression analyses were conducted.
  
  
  RESULTS
  Seventy-six older patients underwent a PD. Significant unrecognized vulnerability was identified at the baseline: Fried's "exhaustion" (37.3%), SPPB <10 (28.5%), and VES-13 >3 (15.4%). Within 30 days of PD, 46% experienced a severe complication (Clavien-Dindo grade ≥III). In regression analyses controlling for age, the body mass index, the American Society of Anesthesiologists score, and comorbidity burden, Fried's "exhaustion" predicted major complications [odds ratio (OR) = 4.06; P = 0.01], longer hospital stays (β = 0.27; P = 0.02), and surgical intensive care unit admissions (OR = 4.30; P = 0.01). Both SPPB (OR = 0.61; P = 0.04) and older age predicted discharge to a rehabilitation facility (OR = 1.1; P < 0.05) and age correlated with a lower likelihood of hospital readmission (OR = 0.94; P = 0.02).
  
  
  CONCLUSIONS
  Controlling for standard preoperative assessments, worse scores on GA prospectively and independently predicted important adverse outcomes. Geriatric assessment may help identify older patients at high risk for complications from PD.
authors.affiliation: *Section of Geriatrics and Palliative Medicine, Department of Medicine †Section of Hematology/Oncology, Department of Medicine ‡Department of Surgery, the University of Chicago, Chicago, IL.
authors.forename: William
authors.initials: W
authors.lastname: Dale
authors.forename: Joshua
authors.initials: J
authors.lastname: Hemmerich
authors.forename: Alaine
authors.initials: A
authors.lastname: Kamm
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Posner
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Matthews
authors.forename: Randi
authors.initials: R
authors.lastname: Rothman
authors.forename: Aparna
authors.initials: A
authors.lastname: Palakodeti
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Roggin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010359:Patient Readmission / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends